Context:Among persons diagnosed as having diabetes mellitus, the prevalence of foot ulcers is 4%to 10%, the annual population-based incidence is 1.0%to 4.1 %, and the lifetime incidence may be as high as 25%. These ulcers frequently b ecome infected, cause great morbidity, engender considerable financial costs, an d are the usual first step to lower extremity amputation. Objective:To systemat ically review the evidence on the efficacy of methods advocated for preventing d iabetic foot ulcers in the primary care setting. Data Sources, Study Selection, and Data Extraction:The EBSCO, MEDLINE, and the National Guideline Clearinghous e databases were searched for articles published between January 1980 and April 2004 using database-specific keywords. Bibliographies of retrieved articles wer e also searched, along with the Cochrane Library and relevant Web sites. We revi ewed the retrieved literature for pertinent information, paying particular atten tion to prospective cohort studies and randomized clinical trials. Data Synthesi s:Prevention of diabetic foot ulcers begins with screening for loss of protecti ve sensation, which is best accomplished in the primary care setting with a brie f history and the Semmes-Weinstein monofilament. Specialist clinics may quantif y neuropathy with biothesiometry, measure plantar foot pressure, and assess lowe r extremity vascular status with Doppler ultrasound and ankle-brachial blood pr essure indices. These measurements, in conjunction with other findings from the history and physical examination, enable clinicians to stratify patients based o n risk and to determine the type of intervention. Educating patients about prope r foot care and periodic foot examinations are effective interventions to preven t ulceration. Other possibly effective clinical interventions include optimizing glycemic control, smoking cessation, intensive podiatric care, debridement of c alluses, and certain types of prophylactic foot surgery. The value of various ty pes of prescription footwear for ulcer prevention is not clear. Conclusions:Sub stantial evidence supports screening all patients with diabetes to identify thos e at risk for foot ulceration. These patients might benefit from certain prophyl actic interventions, including patient education, prescription footwear, intensi ve podiatric care, and evaluation for surgical interventions.

Preventing foot ulcers in patients with diabetes

PURPOSE

To use objective monitoring of physical activity to determine the percentages of children and youth in a population that met physical activity guidelines.

METHODS

A total of 375 students in grades 1–12 wore an accelerometer (CSA 7164) for seven consecutive days. Bouts of continuous activity and accumulation of minutes spent in physical activity at various intensities were calculated to determine how many students met three physical activity guidelines.

RESULTS

Over 90% of students met Healthy People 2010, Objective 22.6 and nearly 70% met the United Kingdom Expert Consensus Group guideline, both of which recommend daily accumulation of moderate physical activity. Less than 3% met Healthy People 2010, Objective 22.7, which calls for bouts of continuous vigorous physical activity. For the United Kingdom Expert Consensus Group guideline, compliance decreased markedly with age, but gender differences were not statistically significant.

CONCLUSIONS

Prevalence estimates for compliance with national physical activity guidelines varied markedly for the three guidelines examined. Objective monitoring of physical activity in youth appears to be feasible and may provide more accurate prevalence rates than self-report measures.

Compliance with physical activity guidelines : prevalence in a population of children and youth

Background: The rapidly rising incidence of papillary thyroid cancer may be due to overdiagnosis of a reservoir of subclinical disease. To conclude that overdiagnosis is occurring, evidence for an association between access to health care and the incidence of cancer is necessary. Methods: We used Surveillance, Epidemiology, and End Results (SEER) data to examine U.S. papillary thyroid cancer incidence trends in Medicare-age and non–Medicare-age cohorts over three decades. We performed an ecologic analysis across 497 U.S. counties, examining the association of nine county-level socioeconomic markers of health care access and the incidence of papillary thyroid cancer. Results: Papillary thyroid cancer incidence is rising most rapidly in Americans over age 65 years (annual percentage change, 8.8%), who have broad health insurance coverage through Medicare. Among those under 65, in whom health insurance coverage is not universal, the rate of increase has been slower (annual percentage change, 6.4%). Over thre...

The increasing incidence of thyroid cancer: the influence of access to care.

Alcohol drinking is an established risk factor for several malignancies, and it is a potentially modifiable risk factor for cancer. The Cancer Prevention Committee of the American Society of Clinical Oncology (ASCO) believes that a proactive stance by the Society to minimize excessive exposure to alcohol has important implications for cancer prevention. In addition, the role of alcohol drinking on outcomes in patients with cancer is in its formative stages, and ASCO can play a key role by generating a research agenda. Also, ASCO could provide needed leadership in the cancer community on this issue. In the issuance of this statement, ASCO joins a growing number of international organizations by establishing a platform to support effective public health strategies in this area. The goals of this statement are to:• Promote public education about the risks between alcohol abuse and certain types of cancer;• Support policy efforts to reduce the risk of cancer through evidence-based strategies that prevent exce...

https://ascopubs.org/doi/pdfdirect/10.1200/JCO.2017.76.1155

Alcohol and Cancer: A Statement of the American Society of Clinical Oncology

Culture consists of shared beliefs, ideas, and symbols among a group of people. Culture guides our placement of meaning in the world; it channels our behavior. All realms of human endeavor hang in webs of cultural norms and expectations—including medicine. Consider the following questions: What is the relationship between health beliefs and accepted treatments? How are biological processes influenced by culture? What happens when Western medicine is introduced into a foreign culture? And, how are people chosen and trained in a curing system? Questions such as these fill the minds and works of medical anthropologists who study the relationships among culture, health, and illness. Health professionals are increasingly turning to medical anthropology to learn how people from different cultural backgrounds define and explain illness and what types of treatments they believe are effective. Medical anthropology is essential to improving health care in our own heterogeneous society and in underdeveloped countries

Culture, Health and Illness: An Introduction for Health Professionals

Background: Adolescence is a crucial period for development of dietary behaviors that continue into adulthood and influence the risk of chronic diseases later in life. The aim of this study was to determine the eating patterns of adolescents’ and their compliance with the Food Guide Pyramid. Methods: 625 students, aged between 11-15 years, from an elementary school in Istanbul, Turkey were enrolled in this cross-sectional survey. A questionnaire of eating patterns (QEP) was administered to all participants. QEP is consisted of questions assessing the knowledge and behaviors on healthy eating, factors affecting food choice, physical activity status and demographical variables. Height and weight of all participants were measured. Physical activity status was determined by questioning about participation in regular sport activities, how much time spent watching TV, playing computer games or doing homework. Results: The mean age of the participants was 12.15 ± 1.15 and 50.5% were female. According to body mass index (BMI) percentiles, 8.3% (52) were obese and 10.2% were overweight. 51% had breakfast every day and only 1.9% met all the recommendations of the Food Guide Pyramid. Among the participants, 31% have fast food at least once every day and 60.8% skip meals. When participants were asked to rate the factors effecting their food choice according to a 10 point Likert scale, the highest mean scores (high impact on food choice) were for the factors; family, health, body perception, teachers and friends; 7.5 ± 3.1, 7.4 ± 3.1, 6.1 ± 3.2, 4.8 ± 3.3 and 4.2 ± 3.0 respectively. Total mean time spent on all passive activities (TV, computer, reading homework etc) per day was 9.8 ± 4.7 hours. Conclusions: In this study we have demonstrated that, adolescents do not have healthy eating patterns. Educational interventions should be planned to decrease the health risks attributable to their eating behaviors.

/pdf/eating-patterns-of-turkish-adolescents-a-cross-sectional-3op16k9v3k.pdf

Eating patterns of Turkish adolescents: a cross-sectional survey

The objective of this study is to determine the incidence and degree of anterior clinoid process pneumatization, in addition highlighting to their clinical significance. Multidetector-row CT scans of the skull base were reviewed in 648 subjects between 2007 and 2008. The presence of pneumatized anterior clinoid process and its degree were studied and documented. These datas were istatistically analyzed. Pneumatization of the ACP was found in 62 of 648 patients (9.6%) including 32 (51.6%) men and 30 (48.4%) women. The age of these patients ranged from 21 to 82 years (mean, 41 ± 15.7 years). Pneumatization of the ACP occurred only on the left side in 14 cases (22.6%), only on the right side in 11 cases (17.7%), and bilaterally in 37 patients (59.7%). ACP pneumatization Type I, in which less than 50% of the ACP is pneumatized, was found in 47 of 124 sides (38%), Type II, in which more than 50% but not totally pneumatized ACP, was found in 28 of 124 sides (22.6%), and Type III, in which the ACP is totally pneumatized, was found in 22 of 124 sides (17.7%). The incidence of Type I in the general population was 6.6%, Type II was 3.5%, and Type III was 2.5%. Radiologically recognizing the degree of ACP pneumatization is important in decreasing the incidence of surgical complications during anterior clinoidectomy. Proper intraoperative management can be undertaken with special attention to the new classification.

Pneumatization degree of the anterior clinoid process: a new classification

Objective To determine the frequency and pattern of energy drink consumption among medical school students, their knowledge of its effects and side effects and to see its relation with alcohol and cigarette usage. Method The descriptive analytical study was conducted at Marmara University Medical School, Istanbul, Turkey from October 2011 and January 2012. A semi-structured questionnaire was filled by students who were asked about their socio-demographic status and their energy drink consumption. SPSS 12 was used for statistical analysis. Results The mean age of the 390 students in the study was 20.98+/-1.96 years (range:16-27). Of them, 204 (52.3%) were females and 186 (47.7%) were males. Overall 52(13.3%) were smoking regularly at least one cigarette per day; 122(31.3%) were consuming alcohol; 127 (32.6%) had consumed energy drinks at least once and 73(18.8%)more than once. In terms of perception, 110(28.2%) students said energy drinks were similar to sports drinks, while only 121(41.1%) named the brands correctly; 96 (24.6%) students did not answer this particular question. Conclusion Although consumption of energy drinks was common among medical students, the knowledge of ingredients and knowledge of health risks of energy drinks among them was unsatisfactory.

A survey of energy-drink consumption among medical students.

Background : Although racial and ethnic variations in the morphology of anatomical
structures are defined well, the size, shape, and weight of the thyroid gland have
not previously been reported in Turkish people. This study provides data about the
morphometric features of the thyroid gland, thyroid lobes, and pyramidal lobe, and
highlights some anatomical variations in people from the Marmara region in Turkey.
 Material and methods : The material for the present study consisted of thyroid glands
obtained from 75 male and 15 female adult cadavers aged between 18 and 80 years.
A dissection was carried out and the thyroid glands were exposed. The glands were
weighed and measured according to the various age groups of the patients.
 Results : A pyramidal lobe was found to be present in 57.8% of the cadavers
(52/90). During midline dissection of the neck 2 males out of 90 cadavers,
giving an incidence of 2.22%, did not show an isthmus. The mean thyroid
weight was 26.11 ± 8.14 g. In males it was 26.93 ± 7.96 g while in females it
was 21.93 ± 7.98 g.
 Conclusions : This is the first reported morphometric study on cadaveric thyroid
glands from Turkey and it highlights individual and ethnic/racial variations.
In order to perform safe and effective surgery and for the accurate diagnosis of
thyroid disorders, knowledge of normal anatomy and the variations of the thyroid
gland are essential. (Folia Morphol 2011; 70, 2: 103–108)

Morphometric features of the thyroid gland: a cadaveric study of Turkish people.

Study Group for Diabetic Foot Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist societies and the Ministry of Health to issue a national consensus report on the diagnosis, treatment and prevention of diabetic foot (DF) wounds and diabetic foot infections (DFIs) in Turkey. In the periodical meetings of the assigned representatives from all the parties, various questions as to pathogenesis, microbiology, assessment and grading, treatment, prevention and control of diabetic foot were identified. Upon reviewing related literature and international guidelines, these questions were provided Özet Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Diyabetik Ayak İnfeksiyonları Çalışma Grubu, ülkemiz koşullarında diyabetik ayak (DA) yarasının ve DA infeksiyonu (DAİ)’nun tanısı, tedavisi ve önlenmesine yönelik bir ulusal uzlaşı raporu hazırlamak üzere ilgili ulusal uzmanlık derneklerine ve Sağlık Bakanlığı’na işbirliği çağrısında bulunmuştur. Görevlendirilen temsilcilerin periyodik olarak yaptığı toplantılarda ilgili literatür ve uluslararası kılavuzlar gözden geçirilerek, patogenez, mikrobiyoloji, değerlendirme ve derecelendirme, tedavi, korunma ve kontrol konularında yanıt verilmesi gereken sorular saptanmış ve bu sorulara üzerinde uzlaşılan yanıtlar verilmişSaltoğlu N et al. Diyabetik Ayak Yarası ve İnfeksiyonunun Tanısı, Tedavisi ve Önlenmesi 3 with consensus answers. Several of the answers provided in the report are listed below: [1] Although there are many reasons for the development of DF wounds, the main reason is the combined effect of diabetes-related vascular disease and neuropathy. [2] Aerobic Gram-positive cocci are mostly responsible for superficial DFIs in patients with cellulitis and no history of antibiotic use. [3] Pseudomonas aeruginosa is one of the commonly encountered agents when between the toes of the patient are moist. [4] When the other potential reasons are eliminated, DFIs should be considered in presence of at least two of the classical signs of inflammation including redness, warmth, swelling, tenderness, and pain, or purulent discharge in the foot lesion. [5] Infections are classified into mild, moderate, or severe groups according to some criteria such as the depth and width of the wounds, and the presence of systemic findings of infection. [6] PEDIS system should be preferred as a classification system for its high predictive value in diabetes-related foot complications. [7] Culture samples from the DF wound should only be obtained when infection is clinically considered and, where possible, before starting antibiotic treatment. [8] Inflammatory biomarkers such as leukocyte count, C-reactive protein, erythrocyte sedimentation rate, and procalcitonin may be useful in distinguishing between colonization with infection. [9] Magnetic resonance imaging is a sensitive and specific method in patients unresponsive to treatment when osteomyelitis and deep soft tissue abscesses are considered. [10] The gold standard in the diagnosis of osteomyelitis is histopathological examination. [11] To provide wound healing and to save the limb, removal of dead and infected tissue with urgent and aggressive debridement, appropriate antibiotic therapy, metabolic control, and off-loading of pressure, the diagnosis and proper treatment of peripheral arterial disease, and restoration of the foot function are necessary. [12] A lot of different factors playing a role in etiopathogenesis complicate the approach to be developed in this type of lesions, and therefore it requires a team concept. [13] In the empirical treatment, the objective should be treating only the potential agents. Adequate tissue levels, low side effects and patient compliance must be observed; effective drugs should be used in specified doses and duration. [14] Debridement is an essential and integral part of wound treatment and is an important tool allowing the formation of healthy granulation tissue. [15] When the infected tissue cannot be completely cleared with the debridement and in cases when the patient could not cope with the remaining infection load, performing a limb amputation on a safe level of infection would be lifesaving. [16] If an arterial insufficiency is considered in a patient with a DF wound, early diagnosis and interventional treatment is necessary. [17] Hyperbaric oxygen therapy is used as an adjunctive treatment in combination with other treatments in DFI patients. [18] Topical negative pressure therapy is a useful adjunctive measure in selected patients. [19] Growth factors can be used in selected patients other than wounds that can be treated with cheaper and safer methods. [20] Maggot therapy may be considered as a debridement method in DF wound cases. [21] Patients with more than ten years of diabetes history have an increased risk of wound development or amputation. [22] DF problem is the only complication of diabetes that can be prevented through education. Klimik Dergisi 2015; 28(Suppl. 1): 2-34.

Ozlem Tanriover

Papers

Eating patterns of Turkish adolescents: a cross-sectional survey

Pneumatization degree of the anterior clinoid process: a new classification

A survey of energy-drink consumption among medical students.

Morphometric features of the thyroid gland: a cadaveric study of Turkish people.

Diagnosis, Treatment and Prevention of Diabetic Foot Wounds and Infections: Turkish Consensus Report